| ObjectiveCoronary artery disease(CAD)complicated with diabetes have severe coronary lesions and complicated conditions compared to those without diabetes.This study intends to investigate the characteristics of coronary artery disease in stable CAD(SCAD)patients complicated with diabetes and evaluate the effect of risk factors on the severity of SCAD patients complicated with type 2 diabetes mellitus(T2DM).MethodsA total of 3 068 patients with SCAD and T2DM treated with percutaneous coronary intervention(PCI)from Jul.2014 to Jun.2015 in Fuwai hospital were retrospectively analyzed.Patients were divided into three groups according to SYNTAX(SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery)score:lesions with SYNTAX score range from 0 to 22(n = 2 661)were defined as mild,those with a score of 23 to 32(n = 342)as moderate and those with a score of>32(n = 65)as severe.The relationship between the risk factors and the severity of coronary lesions in patients with SCAD and T2DM was analyzed by ordered Logistic regression.Results1.This study included a total of 3 068 SCAD patients with T2DM,with mean age was 59.7±9.3 years,and of whom 2 214 patients(72.2%)were male.There were 2048 patients(66.8%)had a history of hypertension,and 2 056(67.0%)were diagnosed as hyperlipidemia.The medium course of CAD was 5.6±5.7 years,which of diabetes was 8.5±7.4 years.There were 2661 patients(86.7%)had a SYNTAX score less than 22,with 342 patients(11.1%)had a SYNTAX score more than 22 and less than 32,and 65 patients(2.1%)had a SYNTAX score more than 32.Among the SYNTAX scores>32 group,the patients were older,the duration of hyperlipidemia,duration of CAD was longer,and the proportion of patients with previous history of myocardial infarction and family history of CAD was higher.2.As the SYNTAX score increases,blood glucose levels and Glycosylated haemoglobin Alc(HbAlc)levels increased,and the left ventricular ejection fraction decreases.Patients with SYNTAX score<32 had the highest involement of left anterior descending(LAD)coronary artery,followed by the right coronary artery(RCA),left circumflex artery(LCX),and left main coronary artery(LM).However,in patients with SYNTAX score>32,the lesions of the RCA and LCX were more common.With the increase of SYNTAX score,the incidence of complete total occlusion and diffuse lesions increased significantly,and the medium number of lesions and stents also increased gradually(P<0.001).3.A simple linear analysis showed that among the total population,the variables positively associated with the SYNTAX score were gender(male),age,days of hospitalization,duration of CAD,history of myocardial infarction,frequencies of myocardial infarction,history of coronary artery bypass grafting,hyperlipidemia course,fasting blood glucose,glycated haemoglobin,and left ventricular ejection fraction.These variables were introduced into an ordinal logistic analysis and the results showed that the severity of coronary artery lesions were associated with multiple risk factors of HbAlc levels(OR:3.51,95%CI:2.90?4.25,P<0.001),coronary heart disease course(OR:1.06,95%CI:1.01?1.10,P=0.008)and current smoking(OR:1.49,95%CI:1.27?1.89,P=0.019).ConclusionThe degree of coronary artery disease in patients with CAD and T2DM involving a wide range of severity.Besides,HbA1c level,CAD course and smoking are important risk factors affecting the complexity of the lesions.ObjectivesFor patients with coronary artery disease(CAD),choosing a different revascularization strategy is mainly to reduce the ischemic symptoms,reduce the occurrence of major cardiovascular events,and improve the quality of life.This study intends to explore the status of different revascularization strategies for patients with CAD complicated with type 2 diabetes mellitus(T2DM),and to compare the influences of revascularization strategy for coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)on short-term health status of patients with CAD and T2DM.MethodsA total of 3 825 patients with stable CAD complicated with T2DM who underwent PCI and CABG surgery in Fuwai hospital from July 1,2014 to June 30,2015 were retrospectively analyzed(PCI group = 3 068,CABG group = 757).A total of 183 patients with complex lesions(SYNTAX score more than 32)were followed up with Seattle Angina Questionnaire.Univariate and multivariate Cox regression analysis was used to assess factors that influence long-term quality of life.Results1.The mean age of the 3 068 patients in the PCI group was 59.7±9.3 years,there were 40 patients(1.3%)were older than 80 years old,and 921 patients(30.0%)were older than 65 years.Among which 72.2%(2 214 patients)were men,with 2 048 cases(66.8%)had hypertension and 2 056 cases(67.0%)were hyperlipidemia.The mean duration of diabetes was 8.5±7.4 years;mean preoperative SYNTAX score was 13.6±9.3 points,of which SYNTAX score was>32 points in 65 cases(2.1%),and 407 patients(13.3%)had a SYNTAX score of>22 points.The mean age of 757 patients in the CABG group was 61.0±8.4 years,of which 4 cases(0.5%)were older than 80 years old,and 257 cases(33.9%)were over 65 years of age.Among which 74.8%(566 cases)were men,and 497 cases were complicated with hypertension(65.7)%),and 493 cases(65.1%)had hyperlipidemia,mean duration of diabetes was 9.9±9.5 years;average preoperative SYNTAX score was 24.1±10.7,of which SYNTAX score group>32 points were 119 cases(15.7%),SYNTAX score>22 group were 311 cases(41.1%).2.A total of 184 patients with complex SCAD and T2DM with a SYNTAX score of>32 points were followed up for about 2 years of quality of life.A total of 183 valid questionnaires were followed up.The results showed that the prevalence of unplanned target lesion revascularization(TLR)was significantly higher in the PCI group than CABG group(19.4%vs.4.3%)with a statistically significant difference(P=0.001).The incidences of MACCE and cardiac death in the PCI group was higher than that in the CABG group with no significances,and there were no significant differences in the rates of all-cause mortality,cardiac death,and nonfatal MI.3.The mean follow-up period was approximately 2 years.The results showed there were no statistically significant differences in health status or quality of life between PCI group and CABG group.In the PCI group,the duration of diabetes(HR:1.08,95%CI:1.03 to 1.14,P = 0.003)was an independent risk factor for quality of life after intervention.However,in the CABG group,adjusted for multivariate analysis,the results showed chronic obstructive pulmonary disease(COPD)(HR:3.78,95%CI:2.31?6.17,P<0.001)and hypertension(HR:1.77,95%CI:1.19?2.64,P = 0.005)were independent risk factors for good quality of life after CABG.ConclusionFor patients with complex CAD and T2DM,there were no statistical significant differences in health status or quality of life of CABG and PCI patients at 2 years.The duration of diabetes was an independent risk factor for quality of life after PCI.The history of chronic obstructive pulmonary disease and hypertension were independent risk factors for impaired quality of life after CABG. |
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